Provider Demographics
NPI:1255431649
Name:FARNESS, JUDY L (NP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:L
Last Name:FARNESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 MEDICAL CENTER DR STE 400
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5000
Mailing Address - Country:US
Mailing Address - Phone:915-546-9200
Mailing Address - Fax:915-546-9800
Practice Address - Street 1:1626 MEDICAL CENTER DR STE 400
Practice Address - Street 2:4TH FLOOR
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5000
Practice Address - Country:US
Practice Address - Phone:915-546-9200
Practice Address - Fax:915-546-9800
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX428622363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188955201Medicaid
TX116201807Medicaid
TX188955203Medicaid
NM45370745Medicaid
TX188955202Medicaid
TX116201807Medicaid
TX8F23371Medicare PIN
TX8G9332Medicare ID - Type Unspecified
NM45370745Medicaid